CONVERGENCE

OF DISCIPLINES AN APPROACH TO HEALTH DISPARITIES RESEARCH

Bailus Walker, Jr, PhD, MPH Professor of Environmental and Occupational Medicine Howard University Rueben Warren, DDS, MPH, DrPH, MDiv Professor of Public Health and Bioethics Tuskegee University April 25, 2012

Convergence of Disciplines
Objectives
To review the complexity of health and disease

with emphasis on health disparities To suggest a new research model --- Convergence --- holds promise for addressing the problem

Convergence of Disciplines
In Retrospect Biological Revolutions
First Revolution; Molecular and Cellular Biology Second Revolution: Genomics (drive to study an

organism entire genomics) Third Revolution: Convergence ---The path forward

Convergence of Disciplines
Progress in Health Improvement
Life expectancy rose again to 78.2 years in 2009 from

78 a year earlier Improved understanding of smoking as a risk factor for multiple diseases Survival rate for cancer is 66%, up from 50% in 1975 CVD prevalence declined from 6.7% to 6.0% -2006 to 2010 THE DOWNSIDE: Health disparities persist

Convergence of Disciplines

The Convergence of the Life Sciences, Physical Sciences, and Engineering

Convergence of Disciplines
THE DOWNSIDE---Health disparities persist
Over the past decade health disparities have not

changed for about 80% of health objective (Healthy People 2010) And have increased for an additional 13% Infant mortality rate 13.3/1000 live births (Blacks) 5.6/1,000 live births (whites) This gap is not explained by poverty, education, smoking, low birth weight alone

Convergence of Disciplines
Health Disparities
African American Women higher rate of

mortality of breast cancer Little is known about environmental risk for breast cancer Association with exposure to 1) ionizing, 2) weight gain after menopause, 3) industrial chemicals, 4) shift work No evidence of risk of hair dyes, cell phones , microwave ovens

Convergence of Disciplines
Health Disparities
Type 2 diabetes poorly understood

Failure to understand the mechanism (biological processes) of diseases such as type 2 diabetes and obesity Frustrates eort to develop improved treatment and prevention strategies

Convergence of Disciplines
Health Disparities
Cardiovascular Disease Disproportionate

burden on minorities Mechanism underlying individual dierences in presentation and pathophysiological features Poorly understood

Convergence of Disciplines
Health Disparities Cardiovascular Disease: Established Risk

Factors

Age Hypertension Diabetes Tobacco use

Account for 50/60% of Cases

Convergence of Disciplines
Health Disparities
Cardiovascular Disease Other Risk Factors: Particulate Air Pollution

qKey factors/characteristics
Particle size Chemical composition of particles Other physical and biological factors

Convergence of Disciplines

Convergence of Disciplines
Cardiovascular Disease
QUESTION: Which chemical components of air

pollution particles is responsible for CVD and other health eects? ANSWER: Unknown IMPLICATIONS: Not possible to target their source for control

Convergence of Disciplines
Concerning Health disparities (HD)
Complex, but important indicators of community

health Research must transcend boundaries of a single disciplines Challenges with ngerprints of science in their causes and in their solutions There may be no single or simple explanation for disparities in life expectancy and mortality There are reason to believe that molecular etiologic forces in individuals may oer an explanation

Convergence of Disciplines
Complexity of Disease, the rationale for

convergence

Cancer is often treated with a combination of

surgery, chemotherapy, radiation QUESTION: why does a particular treatment helps one person with colon cancer. while someone else with same cancer get same treatment, succumbs to the disease Why are cancer cells so dicult to kill?

Convergence of Disciplines
Investments in health disparities has

provided a wealth of information

Not sucient to be translated into intervention

designed to close the gap between black-white morbidity

WHY? Epidemiologist/other scientists

establish associations which seem plausible They are validated when scientists demonstrates a robust biological mechanism

Convergence of Disciplines
Biological Mechanism of the Disease
The cell is the unit structure in living organism Hence, it is in the cell where the eects or risk

factors unfold; The problem is complicated at the cellular level. Examples: complex networks that are interacting and constantly changing

Convergence of Disciplines
Biological Mechanisms of Disease.

IN 1970 Researchers concluded: they could truly understand disease ONLY if they understood it at the molecular level inside the cell

Convergence of Disciplines
Biological Mechanisms of Disease

Complexity

High cholesterol levels are associated with heart

disease Some individuals with high cholesterol level do not develop heart disease Metastasis of a given type of tumor occur with frightening speeds, but not at all in others. (genetic make up and environmental history

Convergence of Disciplines
Biological Mechanism of Disease

Complexity

Question: What is the relationship of an

individuals genetic make up and environmental history to:

Individual health risk Susceptibility to disease Response to treatment

 Convergence of Disciplines
Biological Mechanisms of Disease Another important Consideration
Mechanisms must take into account not only

our human genome but also genomes within the trillions of microorganisms (microbiome) that are associated with each human being Microbiome implicated in a variety of disorders (i.e. metabolic syndrome)

Convergence of Disciplines
In Summary A richer understanding of mechanisms: Provides a basis for increased condence that any given Association is justiably labeled causal. Enhances eorts to identify subpopulation of individuals at substantially dierent degrees of risk (i.e. genetic variations or somatic variations)

Convergence of Disciplines
Implications
Improving human health and addressing health

disparities calls for an understanding of normal biology as a basis for understanding disease biology This complexity requires the integration of the work of many disciplines and professions, which is Convergence of Disciplines

Convergence of Disciplines
What is the Convergence of Disciplines
The merging of new technologies, processing

disciplines, or devices into a unied whole It involve the coming together of dierent eld of study Combining molecular and cellular biology with genomics, engineering and knowledge of the physical sciences Convergence model require not simply collaboration between disciplines but true disciplinary integration

Convergence of Disciplines
What is Convergence
Convergence does not simply involve a transfer of

tools from one science to another It means a broad rethinking how scientic research can be conducted so that we capitalize on a range of knowledge bases from microbiology to computer science to engineering to engineering design.

Convergence of Disciplines

Convergence of Disciplines
Convergence: Example
qConvergence of engineering with life sciences Engineering oer a way of thinking that can contribute substantively to unraveling the inherently complexity of biological science Engineers seek to create systems that can operate reliably Engineering design is almost always undertaken with incomplete information Bringing an engineering mindset to bear on biological questions is already underway

Convergence of Disciplines
Convergence: Issues
Fragmentation within and across institutional

boundaries poses a barrier Research universities are structured around departmental structure ---- analogous to separate governmental agents Scientist: 1) attend separate professional meeting,2) belong to separate professional societies, 3) read separate journals, 4) have separate vocabularies

Convergence of Disciplines

A major scientic challenge over the forthcoming years will be to put mechanist esh on the bare bones of these associations.
Stephen ORahilly